Red flags
- Coma / seizure
- Sulfonylurea overdose (recurrent hypos)
- Neonatal hypoglycaemia
First steps
- Capillary glucose confirm
- Conscious + swallow: fast-acting carb 15-20 g PO
- Unconscious/NBM: 20% dextrose 100 mL IV OR 10% 250 mL IV OR glucagon 1 mg IM
Key investigations
- Serum glucose
- C-peptide, insulin, cortisol if unclear (send during hypo)
Differentials
- Insulin/sulfonylurea overdose
- Alcohol
- Adrenal insufficiency
- Insulinoma
- Post-bariatric
Initial management
- Long-acting carb after correction
- Sulfonylurea: consider octreotide 50 mcg SC + admit
- Address cause: diet, insulin adjustment
Referral
- Diabetes specialist if recurrent
AI clinical assessment
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